Single Dwelling Unit Hot Water System Distribution Project Name: Enforcement Agency: Permit Number:

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1 (Page 1 of 6) A. General Information 01 Dwelling Unit Name B. Design Dwelling Unit Systems Information This table reports the water heating system features that were specified on the registered CF1R compliance document for this project System ID or Name System Heater # of Heaters in system Heater Storage Volume (gal) Fuel Rated Input Rated Input Value Efficiency Efficiency Value Standby Loss (%) Exterior Insul. R Value Central DHW System Distribution Dwelling Unit DHW System Distribution C. Installed Dwelling Unit Systems Information System ID or Name System Heater # of Heaters in system Heater Storage Volume (gal) Fuel Rated Input Rated Input Value Efficiency Efficiency Value Standby Loss (%) Exterior Insul. R Value Central DHW System Distribution Dwelling Unit DHW System Distribution D. Installed Heater Manufacturer Information System ID or Name Manufacturer Model Number

2 (Page 2 of 6) E. MANDATORY MEASURES FOR ALL DOMESTIC HOT WATER DISTRIBUTION SYSTEMS 01 Equipment shall meet the applicable requirements of the Appliance Efficiency Regulations (Section 110.3(b)1). 02 Unfired Storage Tanks are insulated with an external R 12 or combination of R 16 internal and external Insulation. (Section 110.3(c)4). The following pipes are insulated, to the thicknesses required by Table 120.3A, except for those sections of pipe that are subject to one of the exceptions below: (RA4.4.1) The first 5 feet (1.5 meters) of hot and cold water pipes from the storage tank. All piping with a nominal diameter of 3/4 inch (19 millimeter) or larger. All piping associated with a domestic hot water recirculation system regardless of the pipe diameter, except when cold water return is used in a demand system. Piping from the heating source to storage tank or between tanks. 03 Piping buried below grade. All hot water pipes from the heating source to the kitchen fixtures. The following sections of pipe do not have to be insulated: (RA4.4.1) Piping installed in interior or exterior walls that is surrounded on all sides by at least 1 inch of insulation. Piping installed in attics with a minimum of 4 inches (10 cm) of attic insulation on top Piping that penetrates framing members shall not be required to have pipe insulation for the distance of the framing penetration. Metal piping that penetrates metal framing shall use grommets, plugs, wrapping or other insulating material to assure that no contact is made with the metal framing. Insulation shall butt securely against all framing members. Piping buried below grade must be installed in a water proof and non crushable casing or sleeve that allows for installation, removal, and replacement of the enclosed 04 pipe and insulation. (Section 150.0(j)) 05 All elbows and tees shall be fully insulated. (RA4.4.1) 06 Where insulation is required, no piping shall be visible due to insulation voids, and all insulation shall fit tightly to the pipe. (RA4.4.1) For Gas or Propane Heaters: Ensure the following are installed (Section 150.0(n)) 1. A 120V electrical receptacle is within 3 feet from the water heater and accessible with no obstructions A Category III or IV vent, or a B vent with straight pipe between outside and water heater 3. A condensate drain no more than 2 inches higher than the base on water heater for natural draining 4. A gas supply line with capacity of at least 200,000 Btu/Hr F. Standard Distribution System Requirements(trunk and branch systems only) 01 Verification of measures D1 through D8 shows compliance for standard distribution system

3 (Page 3 of 6) G. Pipe Insulation Credit Requirements(For trunk and branch Hot system) 01 All hot water piping shall comply with the insulation requirements in Table A. (RA ) H. Parallel Piping Requirements 01 Each central manifold has 15 feet or less of pipe between manifold and water heater (RA ) 02 For manifolds that include valves, the manifold must be readily accessible in accordance with the plumbing code. (RA 4.4.4) 03 Hot water distribution system piping from the manifold to the fixtures and appliances must take the most direct path. For instance, piping from a second story manifold cannot supply the first floor. (RA 4.4.4) 04 The hot water distribution piping must be separated by at least two inches from any other hot water supply piping, and at least six inches from any cold water supply piping. Alternatively, the hot water supply piping must be insulated to the thicknesses shown in TABLE A. (RA 4.4.4) I. Recirculation Non Demand controls Requirements 01 If more than one loop installed each loop shall have its own pump and controls The active control shall be either: timer, temperature, or time and temperature. Timers shall be set to less than 24 hours. The temperature sensor shall be connected to 02 the piping and to the controls for the pump.

4 (Page 4 of 6) J. Demand Recirculation Manual Control Requirements The system operates on demand, meaning that the pump begins to operate shortly before or immediately after hot water draw begins, and stops when the return 01 water temperature reaches a certain threshold value. (RA4.4.13) After the pump has been activated, the controls shall allow the pump to operate until the water temperature at the thermo sensor rises to one of the following values: (RA4.4.13) 02 Not more than 10 degrees Fahrenheit ( 5.6 degrees Celsius ) above the initial temperature of the water in the pipe Not more than 102 degrees Fahrenheit (38.9 degrees Celsius). The controls shall limit pump operation to a maximum of 10 minutes following any activation. This is provided in the event that the normal means of shutting off the 03 pump have failed. (RA4.4.13) Pump and control placement shall meet one of the following criteria: (RA4.4.13) When a dedicated return line has been installed the pump, controls and thermo sensor are installed at the end of the supply portion of the recirculation loop; or The pump and controls are installed on the dedicated return line near the water heater and the thermo sensor is installed in an accessible location as close to 04 the end of the supply portion of the recirculation loop as possible; or When the cold water line is used as the return, the pump, demand controls and thermo sensor shall be installed in an accessible location at the end of supply portion of the hot water distribution line (typically under a sink). 05 Insulation is not required on the cold water line when it is used as the return. (RA4.4.13) Each control shall have standby power of 1 Watt or less. Controls may be located in individual units or on the loop. Controls may be activated by wired or wireless 06 mechanisms, including buttons, motion sensors, door switches and flow switches. (RA4.4.13) 07 If more than one loop installed each loop shall have its own pump and controls 08 Automatic Air release valve is installed on the inlet side of the recirculation pump per Section 110.3(c)5A. 09 A check valve is located between the recirculation pump and the water heater per Section 110.3(c)5B. Hose bibb is installed between the pump and the water heating equipment with an isolation valve between the hose bibb and the water heating equipment per Section (c)5C. 11 Isolation valves are installed on both sides of the pump. One of the isolation valves may be the same isolation valve as in item 10 above per Section 110.3(c)5D. 12 The cold water supply piping and the recirculation loop piping is not connected to the hot water storage tank drain port per Section 110.3(c)5E. 13 A check valve is installed on the cold water supply line between the hot water system and the next closest tee on the cold water supply per Section 110.3(c)5F.

5 (Page 5 of 6) K. Demand Recirculation Sensor Control Requirements The system operates on demand, meaning that the pump begins to operate shortly before or immediately after hot water draw begins, and stops when the return 01 water temperature reaches a certain threshold value. (RA4.4.13) After the pump has been activated, the controls shall allow the pump to operate until the water temperature at the thermo sensor rises to one of the following values: (RA4.4.13) 02 Not more than 10 degrees Fahrenheit ( 5.6 degrees Celsius ) above the initial temperature of the water in the pipe Not more than 102 degrees Fahrenheit (38.9 degrees Celsius). The controls shall limit pump operation to a maximum of 10 minutes following any activation. This is provided in the event that the normal means of shutting off the 03 pump have failed. (RA4.4.13) Pump and control placement shall meet one of the following criteria: (RA4.4.13) When a dedicated return line has been installed the pump, controls and thermo sensor are installed at the end of the supply portion of the recirculation loop; or The pump and controls are installed on the dedicated return line near the water heater and the thermo sensor is installed in an accessible location as close to 04 the end of the supply portion of the recirculation loop as possible; or When the cold water line is used as the return, the pump, demand controls and thermo sensor shall be installed in an accessible location at the end of supply portion of the hot water distribution line (typically under a sink). 05 Insulation is not required on the cold water line when it is used as the return. (RA4.4.13) Each control shall have standby power of 1 Watt or less. Controls may be located in individual units or on the loop. Controls may be activated by wired or wireless 06 mechanisms, including buttons, motion sensors, door switches and flow switches. (RA4.4.13) 07 If more than one loop installed each loop shall have its own pump and controls 08 Automatic Air release valve is installed on the inlet side of the recirculation pump per Section 110.3(c)5A. 09 A check valve is located between the recirculation pump and the water heater per Section 110.3(c)5B. Hose bibb is installed between the pump and the water heating equipment with an isolation valve between the hose bibb and the water heating equipment per Section (c)5C. 11 Isolation valves are installed on both sides of the pump. One of the isolation valves may be the same isolation valve as in item 8 above per Section 110.3(c)5D. 12 The cold water supply piping and the recirculation loop piping is not connected to the hot water storage tank drain port per Section 110.3(c)5E. 13 A check valve is installed on the cold water supply line between the hot water system and the next closest tee on the cold water supply per Section 110.3(c)5F.

6 (Page 6 of 6) DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Company Name: Address: City/State/Zip: Documentation Author Signature: Date Signed: CEA/HERS Certification Identification (If applicable): Phone: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Installation is true and correct. 2. I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation, and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 5. I will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Address: Position With Company (Title): CSLB License: City/State/Zip: Phone Date Signed:

7 USER INSTRUCTIONS (Page 1 of 2) Instructions to CF2R PLB 02 A. Dwelling Unit Name 01 This identifies the dwelling unit on this form and is reference from the CF1R. One form is required for each dwelling unit in the building. B. Design Central Systems Information This table reports the water heating system features that were specified on the registered CF1R compliance document for this project. For information only and requires no user input. C. Installed Central Systems Information This table reports the water heating system information that is being installed. Require one line for each central system. 01 System ID or Name Reference information from CF 1R 02 System Reference information from CF 1R. The different kinds of water heating system type are DHW, or Combined Hydronic 03 Heater Information from CF 1R. The different kinds of water heaters are Large Storage, Small Storage, Heat Pump, Boiler, Large Instantaneous, Small Instantaneous or Indirect 04 # of Heaters in system Reference information from CF 1R 05 Heater Storage Volume (gal) User input. Value may be N/A if water heater type is instantaneous with zero storage.. 06 Fuel Reference information from CF 1R. The different kinds of fuel types are natural gas, propane, oil, or electricity. 07 Rated Input Reference information from CF 1R. For natural gas, propane and oil fuel type the input type is Btu/Hr. For electric the input type is kw 08 Rated Input Value User input. Numerical value of the rated input. Must be equal to or less than value indicated on the CF 1R 09 Efficiency Reference information from CF 1R. Different efficiency types are Energy Factor, AFUE, and Thermal Efficiency 10 Efficiency Value User input. Numerical value of the Efficiency. Must be equal to or higher efficiency than value indicated on the CF 1R 11 Standby Loss User input. Must be equal to or less than value indicated on the CF 1R. Value may be N/A if CF 1R value is N/A. 12 Exterior Insul. R Value User input. Must be equal to or higher than value indicated on the CF 1R. Value may be N/A if CF 1R value is N/A. 13 Central DHW System Distribution Reference information from CF 1R 14 Dwelling Unit DHW System Distribution Reference information from CF 1R D. Installed Heater Manufacturer Information This table reports the manufacturer information of the installed water heater(s). Require one line for each installed water heater 01 System ID or Name Reference information from CF 1R. 02 Manufacturer User input. Enter the name of the water heater manufacturer. 03 Model Number User input. Enter the model number of the water heater. E. MANDATORY MEASURES FOR ALL DOMESTIC HOT WATER DISTRIBUTION SYSTEMS This table lists the requirements for all central recirculation systems. Installer must ensure all the requirements on this table are met.

8 USER INSTRUCTIONS (Page 2 of 2) F. Standard Distribution System Requirements (trunk and branch systems only) This table only applies to systems indicated in B14 and C14 as Standard Distribution System. In additional the mandatory requirements in Table E, the installer must ensure the requirements on this table are met. G. Pipe Insulation Credit Requirements (For trunk and branch Hot system) This table only applies to systems indicated in B14 and C14 as Pipe Insulation Credit. In additional the mandatory requirements in Table E, the installer must ensure the requirements on this table are met. H. Parallel Piping Requirements This table only applies to systems indicated in B14 and C14 as Parallel Piping. In additional the mandatory requirements in Table E, the installer must ensure the requirements on this table are met. I. Recirculation Non demand controls Requirements This table only applies to systems indicated in B14 and C14 as Recirculation Non demand controls. In additional the mandatory requirements in Table E, the installer must ensure the requirements on this table are met. J. Demand Recirculation Manual Control Requirements This table only applies to systems indicated in B14 and C14 as Demand Recirculation Manual Control. In additional the mandatory requirements in Table E, the installer must ensure the requirements on this table are met. K. Demand Recirculation Sensor Control Requirements This table only applies to systems indicated in B14 and C14 as Demand Recirculation Senor Control. In additional the mandatory requirements in Table E, the installer must ensure the requirements on this table are met.